MODULE 5: Relationship Self-Assessment & Quiz Pack

A healthy relationship requires regular maintenance and self-awareness. Just as you check the dashboard of your car to ensure all systems are running smoothly, taking time to assess your relationship’s health helps you identify small issues before they escalate into major crises.

This self-assessment and quiz pack is designed to help you and your partner gain clear, objective insights into your relationship dynamics. By answering these questions honestly and sharing your results with each other, you can open up meaningful, non-defensive conversations about where your partnership is thriving and where it needs a little extra care.

Instructions: Before assessing your partnership, take a moment to reflect on your own personal relationship habits, beliefs, and emotional patterns. Rate each statement on a scale of 1 (Never) to 5 (Always).

1. 1
   I am aware of my personal emotional triggers and can recognize when I am starting to feel defensive or overwhelmed. Rating:
2. 2
   I can express my needs, boundaries, and feelings clearly and directly without using passive-aggressive behaviors. Rating:
3. 3
   I am willing to take responsibility for my part in a conflict, apologize sincerely, and work toward repair. Rating:
4. 4
   I can listen to my partner’s feedback or complaints without immediately launching a counter-attack or making excuses. Rating:
5. 5
   I regularly practice self-soothing techniques (deep breathing, taking a pause) when my emotions start to run high. Rating:
6. 6
   I actively support my partner’s personal growth, hobbies, and dreams, even if they differ from my own. Rating:

Individual Reflection Questions:

• What is one personal habit or pattern you bring to the relationship that you would like to improve?
• How do you typically react when you feel hurt, criticized, or emotionally unsafe?

Instructions: Both partners should complete this quiz individually. Read each statement and circle the number that best represents your experience in the relationship:

Category A: Emotional Connection & Closeness

1. 1
   I feel deeply connected to my partner on an emotional level. Score: 1 2 3 4 5
2. 2
   My partner is the first person I want to talk to when I have good or bad news. Score: 1 2 3 4 5
3. 3
   We make time for regular, distraction-free quality time together. Score: 1 2 3 4 5
4. 4
   I feel safe sharing my deepest vulnerabilities, fears, and dreams with my partner. Score: 1 2 3 4 5
5. 5
   We regularly touch, hug, kiss, and express physical affection. Score: 1 2 3 4 5

Category A Total: / 25

Category B: Communication & Conflict Resolution

1. 1
   We can discuss difficult topics calmly and respectfully without it turning into a fight. Score: 1 2 3 4 5
2. 2
   I feel truly heard, validated, and understood by my partner when I speak. Score: 1 2 3 4 5
3. 3
   We avoid using sarcasm, insults, name-calling, or eye-rolling during disagreements. Score: 1 2 3 4 5
4. 4
   After an argument, we are able to apologize, repair our connection, and let go of resentment. Score: 1 2 3 4 5
5. 5
   We use "I" statements to express our feelings rather than placing blame on each other. Score: 1 2 3 4 5

Category B Total: / 25

Category C: Trust, Safety & Commitment

1. 1
   I have complete confidence in my partner’s honesty, loyalty, and dependability. Score: 1 2 3 4 5
2. 2
   I feel emotionally and physically safe in my relationship at all times. Score: 1 2 3 4 5
3. 3
   We respect each other’s personal boundaries, privacy, and individuality. Score: 1 2 3 4 5
4. 4
   I believe we are a team and that we make major life decisions together. Score: 1 2 3 4 5
5. 5
   I am fully committed to the long-term future of our relationship. Score: 1 2 3 4 5

Category C Total: / 25

Category D: Shared Meaning & Goals

1. 1
   We share similar core values, beliefs, and priorities in life. Score: 1 2 3 4 5
2. 2
   We have meaningful rituals, traditions, or routines that bring us closer together. Score: 1 2 3 4 5
3. 3
   My partner actively supports my personal dreams, career goals, and self-growth. Score: 1 2 3 4 5
4. 4
   We have a clear, exciting, and shared vision for our future as a couple. Score: 1 2 3 4 5
5. 5
   We regularly laugh, play, and have fun together. Score: 1 2 3 4 5

Category D Total: / 25

Add up your scores for all four categories to get your Grand Total (Out of 100):

Instructions: Sit down with your partner and compare your quiz results. Answer the following questions together in a calm, non-defensive environment:

1. 1
   Which category scored the highest for both of you? Take a moment to celebrate this strength and discuss why this area feels so strong.
2. 2
   Which category scored the lowest for one or both of you? What specific behaviors or patterns do you think contribute to this lower score?
3. 3
   What is one small, actionable change each of you can commit to making this week to help improve your lowest-scoring category? (e.g., "I will put my phone away during dinner to help improve our Emotional Connection score.")